Palliative Care Sells Itself

Early integration of palliative care into oncology programs improves quality of life for patients and caregivers, increases prognostic understanding, and demonstrates survival benefits while substantially reducing costs, according to an interview conducted at the Association of Community Cancer Centers 2014 National Oncology Conference.

In the interview, Joseph Greer, PhD, a clinical psychologist who was instrumental in developing the cancer outcomes research program at the Massachusetts General Hospital Cancer Center, discussed findings from a study of patients with metastatic non–small-cell lung cancer. In the study, overseen by Greer, patients receiving palliative care at the time of diagnosis (with continuous contact in the outpatient setting every month) showed a survival benefit of 2.5 months and a savings of $117 per patient per day over the course of the disease.

Greer emphasized the importance of palliative care—even without the unexpected benefits of survival and cost. “This trial showed wonderful outcomes for patients,” he said. “They had improved quality of life, lower rates of depression…and their sense of whether their cancer was curable was more accurate….The fact that these patients were living better really makes a huge difference.”

Also interviewed at the meeting was Brian Bell, MD, a physician who specializes in hospice and palliative care at the Spartanburg Regional Healthcare System in South Carolina. Bell distinguished palliative care from traditional therapy for its communal character. “We work as a team,” he said. “We offer care that can’t be provided simply from a doctor or a nurse practitioner—we have social workers with PhDs and chaplains, too….No one person can single-handedly deliver the type of multidimensional care our patients need.”

Credibility Is Key
Both doctors stressed the importance of building a relationship with patients early in their treatment and the need to establish credibility.

“We love to see our patients early on,” said Bell. “We’re seeing them more at the time of the diagnosis, especially for the advanced cancers.”

“One of the toughest situations is the crisis moment,” Greer concurred, “so the benefit of the early palliative care is that you have a chance to know patients when they’re fairly stable and doing well and know what they care about in their lives, and you’ve established that credibility.”

Just as integral to this relationship-building is the location of care—away from the hospital’s often hectic milieu. “The home visit is impor­tant,” said Bell. “When you’re in the hospital, it’s a stressful place to be. When you go to somebody’s home…they’re much more comfortable. You’re on their turf. And I think that relationship goes much better. The dynamic changes.”

If end-of-life care is not done well, it’s not just the patient who suffers. There are ramifications for family members, too, including posttraumatic stress disorder. “It’s critical that caregivers receive the support they need,” urged Bell, “because after the patient dies, they still have to live with all the things that happened.”

Finally, according to both doctors, the early integration of palliative care is critical not just for patients and caregivers but for clinicians as well. “We had to learn how to integrate with the other clinicians because many oncologists feel that this is their job,” said Greer. “And I have to say, in terms of symptom management and illness understanding and treatment decision making, that it is their job. We look at it as a comanagement model.”

Although palliative care physicians may experience some initial reluctance from oncologists, Greer concluded with the following words of encouragement: “Once you start seeing their patients, your value comes across very quickly….Once you’re embedded, palliative care sells itself.”